Provider Demographics
NPI:1518035104
Name:COOK, EWING (MD)
Entity Type:Individual
Prefix:
First Name:EWING
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EWING
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY
Mailing Address - Street 2:PROVINCE BLDG. 14-A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-234-7779
Mailing Address - Fax:337-235-7246
Practice Address - Street 1:5000 AMBASSADOR CAFFERY
Practice Address - Street 2:PROVINCE BLDG. 14-A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-234-7779
Practice Address - Fax:337-235-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011080207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191868Medicaid
LA51007Medicare PIN
LA1191868Medicaid